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General NPI Number Information
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NPI Number | 1972544062
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Entity Type | Individual
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Provider Name | MARISSA B. WEISS-BAKER DO
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 300 LEXINGTON RD STE 200
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City | WOOLWICH TOWNSHIP
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State | NJ
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Zip | 08085-1278
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Country | US
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Telephone | 856-241-2111
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Fax | 856-241-2243
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Provider Business Mailing Address
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Address Line | 307 S EVERGREEN AVE
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City | WOODBURY
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State | NJ
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Zip | 08096-2739
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Country | US
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Telephone | 856-686-4300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MB71280
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License Number State | NJ
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